Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.011516
Jornal Vascular Brasileiro
Original Article

Cateteres venosos centrais de inserção periférica: alternativa ou primeira escolha em acesso vascular?

Peripherally inserted central venous catheters: alternative or first choice vascular access?

Marcelo Kalil Di Santo, Diogo Takemoto, Robert Guimarães Nascimento, Ariele Milano Nascimento, Érika Siqueira, Caio Túlio Duarte, Marco Antônio Caldas Jovino, Jorge Agle Kalil

Downloads: 4
Views: 1577

Resumo

Contexto: Os cateteres venosos centrais de inserção periférica (PICC) são dispositivos intravenosos, introduzidos através de uma veia superficial ou profunda da extremidade superior ou inferior até o terço distal da veia cava superior ou proximal da veia cava inferior. Apresentam maior segurança para infusão de soluções vesicantes/irritantes e hiperosmolares, antibioticoterapia, nutrição parenteral prolongada (NPT) e uso de quimioterápicos; demonstram reduzido risco de infecção em comparação a outros cateteres vasculares e maior relação custo/benefício se comparados ao cateter venoso de inserção central (CVCIC). Objetivos: Apresentar os resultados de implantes de PICCs ecoguiados e posicionados por fluoroscopia realizados no Hospital e Maternidade São Luiz (HMSL) Itaim, Rede D’or, Brasil. Métodos: Estudo prospectivo, não randomizado, realizado entre fevereiro de 2015 e novembro de 2016. Utilizou-se protocolo pré-estabelecido pela instituição em casos de solicitação de acesso vascular. Foram analisadas indicações, doenças prevalentes, tipo do cateter implantado, sucesso técnico, complicações relacionadas ao cateter, e estabelecidos critérios de inclusão e exclusão. Resultados: Solicitados 256 acessos vasculares, sendo implantados 236 PICCs (92,1%) e 20 CVCICs (7,9%). Principais indicações: antibioticoterapia prolongada (52,0%), NPT (19,3%) e acesso venoso difícil (16,0%). Houve sucesso técnico em 246 cateteres implantados (96,1%). A veia basílica direita foi a principal veia puncionada em 192 pacientes (75,0%), seguida da braquial direita em 28 pacientes (10,9%). Conclusões: O implante dos PICCs ecoguiados e posicionados por fluoroscopia demonstrou baixa incidência de complicações, reduzidos índices de infecção e é seguro e eficaz em casos de acessos vasculares difíceis, sendo esses cateteres considerados dispositivos de escolha em acesso vascular central.

Palavras-chave

cateter central; acesso venoso central; punção ecoguiada; acesso vascular.

Abstract

Background: Peripherally inserted central catheters (PICC) are intravenous devices inserted through a superficial or deep vein of an upper or lower extremity and advanced to the distal third of the superior vena cava or proximal third of the inferior vena cava. They offer the advantages of greater safety for infusion of vesicant/irritant and hyperosmolar solutions and enable administration of antibiotics, prolonged parenteral nutrition (PPN), and chemotherapy agents. They also involve reduced risk of infection compared to other vascular catheters and are more cost-effective than centrally inserted venous catheters (CICVC). Objectives: To present the results of our team’s experience with US-guided and fluoroscopy-positioned PICC placement at the Hospital and Maternidade São Luiz (HMSL) Itaim, Rede D’or, Brazil. Methods: This was a prospective, non-randomized study, conducted from February 2015 to November 2016. The institution’s preestablished protocol was followed when vascular access was requested. Indications, prevalent diseases, type of catheter implanted, technical success, and complications related to the catheters were analyzed and inclusion and exclusion criteria are described. Results: A total of 256 vascular accesses were requested, and 236 PICCs (92.1%) and 20 CICVCs (7.9%) were implanted. The main indications were as follows: prolonged antibiotic therapy (52%), PPN (19.3%), and difficult venous access (16%). Technical successes was achieved in 246 catheter placements (96.1%). The right basilic vein was the most common vein punctured for access, in 192 patients (75%), followed by the right brachial vein, in 28 patients (10.9%). Conclusions: Ultrasound-guided and fluoroscopy-positioned PICC placement had a low incidence of complications, reduced infection rates, and proved safe and effective in cases of difficult vascular access. PICCs can be considered the devices of choice for central vascular access.

Keywords

central catheter; central venous access; ultrasound-guided puncture; vascular access.

References

1. Cournand AF, Forssmann W, Richards DW. Werner Forssmann: biographical. Stockholm: The Nobel Foundation; 2014. http://www.nobelprize.org/nobel_prizes/medicine/laureates/1956/forssmann-bio.html. Acessado: 23/11/2016.

2. Freitas LCM, Raposo LCM, Finoquio RA. Instalação, manutenção e manuseio de cateteres venosos centrais de inserção periférica em pacientes submetidos a tratamento quimioterápico. Rev Bras Cancerol. 1999;45:19-29.

3. Vendramin P. Cateter central de inserção periférica (CCIP). In: Harada MJCS, Rego RC, editores. Manual de terapia intravenosa em pediatria. São Paulo: ELLU; 2005. cap. 7, p. 75-95.

4. Jesus VC, Secoli SR. Complicações acerca do cateter venoso central de inserção periférica (PICC). Cienc Cuid Saude. 2007;6(2):252-60.

5. Periard D, Monney P, Waeber G, et al. Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy. J Thromb Haemost. 2008;6(8):1281-8. PMid:18541001. http://dx.doi.org/10.1111/j.1538-7836.2008.03053.x.

6. Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489-95. PMid:16100130. http://dx.doi.org/10.1378/chest.128.2.489.

7. Chemaly RF, Parres JB, Rehm SJ, et al. Venous thrombosis associated with peripherally inserted central catheters: a retrospective analysis of the Cleveland Clinic experience. Clin Infect Dis. 2002;34(9):1179-83. PMid:11941543. http://dx.doi.org/10.1086/339808.

8. Allen AW, Megargell JL, Brown DB, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol. 2000;11(10):1309-14. PMid:11099241.

9. Dawson RB. PICC Zone Insertion MethodTM (ZIMTM): a systematic approach to determine the ideal insertion site for PICCs in the upper arm. J Assoc Vasc Access. 2011;16(3):156-60, 162-5. http://dx.doi.org/10.2309/java.16-3-5.

10. Dariushnia SR, Wallace MJ, Siddiqi NH, et al. Quality Improvement Guidelines for Central Venous Access. J Vasc Interv Radiol. 2010;21(7):976-81. PMid:20610180. http://dx.doi.org/10.1016/j.jvir.2010.03.006.

11. Mehta N, Valesky WW, Guy A, Sinert R. Systematic review: is realtime ultrasonic-guided central line placement by ED physicians more successful than the traditional landmark approach? Emerg Med J. 2013;30(5):355-9. PMid:22736720. http://dx.doi.org/10.1136/emermed-2012-201230.

12. Hockley SJ, Hamilton V, Young RJ, et al. Efficacy of the CathRite system to guide bedside placement of peripherally inserted central venous catheters in critically ill patients: a pilot study. Critical Care & Resuscitation. 2007;9(3):251-5. PMid:17767451.

13. Krstenic WJ, Brealey S, Gaikwad S, Maraveyas A. The effectiveness of nurse led 2-d ultrasound guided insertion of peripherally inserted central catheters in adult patients: a systematic review. J Assoc Vasc Access. 2008;13(3):120-5. http://dx.doi.org/10.2309/java.13-3-4.

14. McMahon DD. Evaluating new technology to improve patient outcomes: a quality improvement. J Infus Nurs. 2002;25(4):250-5. PMid:12131507. http://dx.doi.org/10.1097/00129804-200207000-00008.

15. Simcock L. No going back: advantages of ultrasound-guided upper arm PICC placement. J Assoc Vasc Access. 2008;13(4):191-7. http://dx.doi.org/10.2309/java.13-4-6.

16. Lobo BL, Vaidean G, Broyles J, Reaves AB, Shorr RI. Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters. J Hosp Med. 2009;4(7):417-22. PMid:19753569. http://dx.doi.org/10.1002/jhm.442.

17. Links DJ, Crowe PJ. Horner’s syndrome after placement of a peripherally inserted central catheter. JPEN J Parenter Enteral Nutr. 2006;30(5):451-2. PMid:16931616. http://dx.doi.org/10.1177/0148607106030005451.

18. Wu ET, Takeuchi M, Imanaka H, Higuchi T, Kagisaki K. Chylothorax as a complication of innominate vein thrombosis induced by a peripherally inserted central catheter. Anaesthesia. 2006;61(6):584-6. PMid:16704595. http://dx.doi.org/10.1111/j.1365-2044.2006.04640.x.

19. Liem TK, Yanit KE, Moseley SE, et al. Peripherally inserted central catheter usage patterns and associated symptomatic upper extremity venous thrombosis. J Vasc Surg. 2012;55(3):761-7. PMid:22370026. http://dx.doi.org/10.1016/j.jvs.2011.10.005.

20. Hoffer EK, Borsa J, Santulli P, Bloch R, Fontaine AB. Prospective randomized comparison of valved versus nonvalved peripherally inserted central vein catheters. AJR Am J Roentgenol. 1999;173(5):1393-8. PMid:10541127. http://dx.doi.org/10.2214/ajr.173.5.10541127.

21. Burns D. The Vanderbilt PICC Service: program, procedural, and patient outcomes successes. J Assoc Vasc Access. 2005;10(4):1-10. http://dx.doi.org/10.2309/java.10-4-10.

22. Hoffer EK, Bloch RD, Borsa JJ, Santulli P, Fontaine AB, Francoeur N. Peripherally inserted central catheters with distal versus proximal valves: prospective randomized trial. J Vasc Interv Radiol. 2001;12(10):1173-7. PMid:11585883. http://dx.doi.org/10.1016/S1051-0443(07)61676-5.

23. Song L, Li H. Malposition of peripherally inserted central catheter: experience from 3.012 patients with cancer. Exp Ther Med. 2013;6(4):891-3. PMid:24137284.

24. Aladangady N, Roy R, Costeloe KL. The cobweb sign: percutaneous silastic long line tip placement in tributaries of superficial veins. J Perinatol. 2005;25(10):671-3. PMid:16193077. http://dx.doi.org/10.1038/sj.jp.7211355.

25. Baskin JL, Reiss U, Wilimas JA, et al. Thrombolytic therapy for central venous catheter occlusion. Haematologica. 2012;97(5):641-50. PMid:22180420. http://dx.doi.org/10.3324/haematol.2011.050492.

26. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-71. PMid:16970212. http://dx.doi.org/10.4065/81.9.1159.

27. Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S. PICCassociated bloodstream infections: prevalence, patterns, and predictors. Am J Med. 2014;127(4):319-28. PMid:24440542. http://dx.doi.org/10.1016/j.amjmed.2014.01.001.

28. Sundriyal D, Shirsi N, Kapoor R, et al. Peripherally inserted central catheters: our experience from a cancer research centre. Indian J Surg Oncol. 2014;5(4):274-7. PMid:25767338. http://dx.doi.org/10.1007/s13193-014-0360-1.

29. Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer. J Clin Oncol. 2013;31(10):1357-70. PMid:23460705. http://dx.doi.org/10.1200/JCO.2012.45.5733.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5cd471090e882512167f3257 jvb Articles

J Vasc Bras

Share this page
Page Sections